Therapeutic Relationships. Concepts of the Nurse-Patient Relationship Basis of all psychiatric...
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Chapter 9 Therapeutic Relationships
Therapeutic Relationships. Concepts of the Nurse-Patient Relationship Basis of all psychiatric nursing treatment approaches To establish that the nurse
Concepts of the Nurse-Patient Relationship Basis of all
psychiatric nursing treatment approaches To establish that the
nurse is Safe Confidential Reliable Consistent Relationship with
clear boundaries
Slide 3
Goals and Functions Facilitate communication of distressing
thoughts and feelings Assist patient with problem solving Help
patient examine self-defeating behaviors and test alternatives
Promote self-care and independence
Slide 4
Social Relationships Initiated for the purpose of friendship or
meeting a goal Mutual needs are met Communication to give advice,
give or ask for help Content of communication superficial
Slide 5
Therapeutic Relationships Needs of patient identified and
explored Clear boundaries established Problem-solving approaches
taken New coping skills developed Behavioral change encouraged
Slide 6
Necessary Behaviors for Nurses Accountability Focus on patients
needs Clinical competence Delaying judgment Supervision
Slide 7
Establishing Boundaries Physical boundaries The contract
Personal space
Slide 8
Blurring of Boundaries When relationship slips into social
context When nurses needs are met at expense of patients needs
Slide 9
Blurring of Roles Transference patient unconsciously displaces
onto individual in current life emotions and behaviors from
childhood that originated in relationships with significant others
Transference intensified with person in authority in current
life
Slide 10
Blurring of Roles Continued Countertransference nurse displaces
feelings related to people in nurses past onto patient Patients
transference to nurse often results in countertransference in nurse
Common sign of countertransference in nurse is overidentification
with the patient
Slide 11
Values, Beliefs, and Self-Awareness Nurses values and beliefs
Not right for everyone Reflect own culture/subculture Derived from
range of choices Chosen from a variety of influences and role
models
Slide 12
Peplaus Model of Nurse-Patient Relationship Orientation phase
Working phase Termination phase
Slide 13
Orientation Phase Establishing rapport Parameters of the
relationship Formal or informal contract Confidentiality Assessing
patient strengths and coping Identification of Nursing Diagnosis
and NOC Terms of termination
Slide 14
Working Phase Maintain relationship Gather further data Clarify
expectations Develop plan of care Promote patients problem-solving
skills self-esteem
Slide 15
Working Phase Continued Facilitate behavioral change Overcome
resistant behaviors Evaluate problems and goals Redefine them as
necessary Promote practice and expression of alternative adaptive
behaviors
Slide 16
Termination Phase Summarize goals and objectives achieved
Discuss ways for patient to incorporate new coping strategies
learned Review situations of relationship Exploring the need for
referrals post-discharge Establish plans for long-term post
discharge functioning
Slide 17
Factors That Help Nurse-Patient Relationship Consistency Pacing
Listening Encouraging active patient collaboration Initial
impressions
Slide 18
Factors That Help Nurse-Patient Relationship Continued
Promoting patient comfort and balancing control Patient factors
include trust and active participation
Slide 19
Factors That Encourage and Promote Patient Growth Genuineness
Empathy (not sympathy) Positive Regard attitudes and actions
Slide 20
Factors That Encourage and Promote Patient Growth Continued
Attending Suspending value judgments Helping patients develop
resources
Slide 21
A nurse seeks to establish a relationship with a patient
readmitted to the hospital. The patient has bipolar disorder,
depressed type, and was hospitalized the preceding month. Which
statement by the nurse would contribute to establishing trust?
Slide 22
Answers a. Werent you complying with your medication regimen?
b. It must be discouraging to be readmitted to the hospital so
soon. c. Everyone with bipolar disorder ends up in the hospital
occasionally. d. You must take your drugs as prescribed or you will
be rehospitalized.
Slide 23
Communication and the Clinical Interview
Slide 24
The Communication Process Stimulus for information, comfort, or
advice Sender initiates contact Message sent or expressed Variety
of media hearing, visual, touch, smell Feedback received
Slide 25
Factors That Affect Communication Personal factors
Environmental factors Relationship factors
Slide 26
Nonverbal Communication Tone of voice Emphasis on certain words
Physical appearance Facial expressions Body posture Amount of eye
contact Hand gestures
Slide 27
Verbal Communication All words a person speaks Communicates
Beliefs and values Perceptions and meaning Can convey Interest and
understanding Insult and judgment Double or mixed messages
Slide 28
Therapeutic Communication Techniques Tools for enhancing
communication Using silence Active listening Listening with
empathy
Asking Questions and Eliciting Patient Responses Open-ended
questions Closed-ended questions
Slide 31
Nontherapeutic Communication Techniques Excessive questioning
Giving approval or disapproval Giving advice Asking why
questions
Slide 32
Cultural Considerations Communication style Eye contact Touch
Cultural filters form of bias or prejudice
Slide 33
Preparing for the Interview Pace Setting Seating Introductions
Initiating the interview
Slide 34
Attending Behaviors Foundation of the interview Eye contact
Body language Vocal quality Verbal tracking
Slide 35
Process Recording Written record of a segment of the
nurse-patient session that reflects as closely as possible the
verbal and nonverbal behaviors of both patient and nurse Useful
tool for identifying communication patterns